Spironolactone
Spironolactone is a medication primarily used as a potassium-sparing diuretic. It helps regulate salt absorption and prevents potassium levels from dropping too low. Additionally, it functions as an anti-androgen.
Spironolactone finds applications in treating various conditions, including heart failure, high blood pressure, hyperandrogenism, hypokalemia (low blood potassium levels), water retention, liver cirrhosis, and the diagnosis and management of excess aldosterone.
In the context of alopecia, spironolactone is a popular treatment choice for women. Many online discussions and forums feature recommendations for its use. It is among the frequently prescribed medications for female hair loss. However, its use in men is less common.
Is it effective for treating hair loss?
To begin with, it’s important to understand how spironolactone works. Spironolactone has various effects on the human body, but in the context of our discussion, we’re interested in its anti-androgenic properties. Unlike other anti-androgens like finasteride, it doesn’t work by inhibiting 5-alpha-reductase; instead, it blocks androgen receptors.
These receptors are present on cells where male hormones like testosterone and dihydrotestosterone (DHT) bind. By blocking these receptors, spironolactone prevents these hormones from exerting their normal functions. This is why spironolactone can be an effective treatment for women who are experiencing issues due to an excess of androgen hormones. However, this is not the case for men, as androgen receptors play a much more significant role in their physiology.
While spironolactone is not typically prescribed as an anti-androgen, doctors may recommend it for various conditions such as acne, hyperandrogenism, or hirsutism in women.
At higher doses, spironolactone is sometimes prescribed to biological males who wish to transition to transgender females.
Based on my research, spironolactone may affect hair loss in the following way:
Research on Spironolactone and Alopecia
Here is a compilation of studies investigating the use of spironolactone in treating female pattern hair loss:
Study 1: Spironolactone and Female Androgenetic Alopecia
In a study conducted in 2015, researchers examined the effects of oral spironolactone in women diagnosed with androgenetic alopecia.
Some women provided self-assessments regarding the medication’s effectiveness, while for others, researchers evaluated the outcomes through patient records. Here are the study results:
In simpler terms, when we combine the results, 54% of the women reported some level of improvement in their hair loss.
Study 2: Minoxidil and Spironolactone for Female Androgenetic Alopecia
In a study from 2017, it was observed that a combination of spironolactone and minoxidil proved effective in treating female androgenetic alopecia. This combination was associated with reduced hair loss, increased hair growth, and thicker hair. (source)
In this study, minoxidil and spironolactone were administered orally at the following dosages: minoxidil 0.25 mg and spironolactone 25 mg.
Study 3: Case Study of a Woman with Androgenetic Alopecia
In a case study, a 53-year-old woman who had androgenetic alopecia was treated with spironolactone and minoxidil.
Initially, the woman received an oral dose of 200 mg of spironolactone per day. Visible hair regrowth was observed at the 12-month mark. Subsequently, the regrowth remained stable after 24 months. At this stage of the study, the treating physician prescribed a twice-daily application of 5% minoxidil solution, and the woman’s hair regrowth resumed.
Figure 1: Start of treatment ; Figure 5: After 2 years of spironolactone
Figure 4: After one year of spironolactone + 5% minoxidil
Study 4: Topical Minoxidil + Spironolactone for Androgenetic Alopecia
In a 2020 study led by Hamza Abdel-Raouf and colleagues, the effects of combining topical minoxidil and spironolactone were examined in patients (both men and women) with androgenetic alopecia. The study also assessed the effectiveness of spironolactone compared to minoxidil.
The participants, consisting of 39 men and 21 women with androgenetic alopecia, were divided into three groups:
- Group 1: Topical 5% minoxidil
- Group 2: Topical 1% spironolactone
- Group 3: Topical 5% minoxidil + 1% spironolactone
After 12 months of applying these treatments twice daily, here are the results:
- Group 1: 5% minoxidil – 90% of patients observed some improvement.
- Group 2: 1% spironolactone – 80% of patients observed some improvement.
- Group 3: 5% minoxidil + 1% spironolactone – 100% of patients observed some improvement.
The study noted that subjects in the combined treatment group were more likely to achieve excellent results compared to the other groups. Additionally, no major side effects were reported by the patients, such as gynecomastia, loss of libido, or other issues.
Study 5: Topical Finasteride and Topical Spironolactone for Androgenetic Alopecia
In a 2020 study led by Ayman E. Yousef and colleagues, the effects of topical finasteride and topical spironolactone were compared in patients (both men and women) with androgenetic alopecia. (source)
In this study, 32 participants were divided into two groups and received treatment for 6 months:
- Group 1: 8 women and 8 men – topical 0.1% finasteride
- Group 2: 8 women and 8 men – topical 5% spironolactone
The results were highly positive, as both finasteride and spironolactone demonstrated significant efficacy against androgenetic alopecia. After 6 months of treatment, 68.7% of men and 87.5% of women noted an increase in hair density.
Importantly, there was no statistically significant difference in the percentage increase in hair count between men and women after treatment. However, the study pointed out that 1% spironolactone was considerably more effective than 0.1% finasteride.
To recap, spironolactone blocks androgen receptors, while finasteride inhibits 5-alpha-reductase to reduce DHT levels.
Spironolactone possesses anti-inflammatory properties.
Inflammation is a defense mechanism of the immune system that is activated when the body faces various challenges, such as infections, irritations, muscle tension, or injuries.
Interestingly, almost all forms of alopecia are characterized by the presence of chronic inflammation in the scalp. Reducing this inflammation has proven effective in mitigating hair loss.
In our case, spironolactone also exhibits anti-inflammatory properties, which could account for its effectiveness in treating certain types of alopecia (source) (source) (source).
It’s worth noting that its anti-inflammatory action may be linked to its anti-androgenic properties, as androgens like DHT are also involved in the body’s inflammatory processes.
As of now, I haven’t come across any studies that conclusively demonstrate spironolactone’s efficacy in treating alopecia areata, a type of inflammatory hair loss. However, topical application may show promise in this regard.
Closing Thoughts and Verdict
I believe that spironolactone, with its anti-androgenic properties, can be a highly effective treatment for androgenetic alopecia.
For women, it can be administered either orally or topically, while for men, only the topical form is recommended.
However, it’s worth noting that obtaining spironolactone can be challenging as it typically requires a prescription from a doctor. Since its primary use is not for androgenetic alopecia, you may need to present strong arguments to your doctor to obtain a prescription. In some countries, certain pharmacies may provide it without a prescription.
Precautions & side effects
As a medication, the side effects are described in detail:
- Possibility of allergic reactions in some individuals.
- Gynecomastia (swelling of the male breast), which generally resolves upon discontinuation of treatment but can persist in rare cases.
- Digestive disturbances.
- Hepatitis (inflammation of the liver).
- Leg cramps (in the legs, feet, etc.).
- Drowsiness.
- Menstrual irregularities in women.
- Impotence in men.
- Skin detachment that can rapidly spread extensively across the body, which can be very serious.
- Drug-induced skin rash with eosinophilia (excessive white blood cell count) and systemic manifestations (affecting different areas).
- Skin rash.
- Pemphigoid (a condition characterized by fluid-filled blisters on the skin).
- Impaired kidney function (acute renal failure).
- Abnormal levels of minerals in the body, such as increased potassium and decreased sodium in the blood.
- Fluid and electrolyte imbalance (e.g., hypomagnesemia, hyponatremia, hypocalcemia, hyperglycemia, hyperkalemia) may occur.
- Patients with heart failure, kidney disease, or cirrhosis may be particularly susceptible.
- Contraindicated in patients with hyperkalemia, Addison’s disease, and concomitant use with eplerenone.
- Erectile dysfunction, irregular menses, mastalgia, postmenopausal bleeding.
- Drug reaction with eosinophilia and systemic symptoms (DRESS).
- If you are on a low-salt or salt-free diet, talk with your doctor.
- Sometimes, this drug may raise potassium levels in the blood. This can be deadly if it is not treated. The risk is highest in people with diabetes, kidney disease, severe illness, and in older adults. Your doctor will follow you closely to change the dose if needed.
- If you are taking a salt substitute that has potassium in it, a potassium-sparing diuretic, or a potassium product, talk with your doctor.
Contraindications:
- If you are allergic to spironolactone.
- If your kidneys are not functioning properly (severe or acute renal insufficiency, moderate renal insufficiency in children).
- If your liver is not functioning properly (end-stage liver failure).
- If you have Addison’s disease, characterized by a deficiency in adrenal gland hormone secretion.
- If you have excessive potassium levels in the blood (hyperkalemia).
- If you are taking other medications such as mitotane and other potassium-sparing diuretics (amiloride, potassium canrenoate, eplerenone, triamterene), unless advised otherwise by your doctor.